Comber, Alexis and Brunsdon, Chris and Radburn, Robert
(2011)
A spatial analysis of variations in health access: linking geography, socio-economic status and access perceptions.
International Journal of Health Geographics, 10 (1).
pp. 44-55.
ISSN 1476-072X
Abstract
Background: This paper analyses the relationship between public perceptions of access to general practitioners
(GPs) surgeries and hospitals against health status, car ownership and geographic distance. In so doing it explores
the different dimensions associated with facility access and accessibility.
Methods: Data on difficulties experienced in accessing health services, respondent health status and car ownership
were collected through an attitudes survey. Road distances to the nearest service were calculated for each
respondent using a GIS. Difficulty was related to geographic distance, health status and car ownership using
logistic generalized linear models. A Geographically Weighted Regression (GWR) was used to explore the spatial
non-stationarity in the results.
Results: Respondent long term illness, reported bad health and non-car ownership were found to be significant
predictors of difficulty in accessing GPs and hospitals. Geographic distance was not a significant predictor of
difficulty in accessing hospitals but was for GPs. GWR identified the spatial (local) variation in these global
relationships indicating locations where the predictive strength of the independent variables was higher or lower
than the global trend. The impacts of bad health and non-car ownership on the difficulties experienced in
accessing health services varied spatially across the study area, whilst the impacts of geographic distance did not.
Conclusions: Difficulty in accessing different health facilities was found to be significantly related to health status and car ownership, whilst the impact of geographic distance depends on the service in question. GWR showed
how these relationships were varied across the study area. This study demonstrates that the notion of access is a
multi-dimensional concept, whose composition varies with location, according to the facility being considered and
the health and socio-economic status of the individual concerned.
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